Innovation and Health Care Reform

Most innovation in health care occurs at the high end: better – and more expensive – drugs, technology, procedures and medical settings driven by the promise of higher revenues and profits.

It’s a money pipeline. Consumers usually don’t pay the bill themselves, public and private payers are accustomed to paying for procedures deemed necessary and appropriate by physicians, the general public is fascinated with gee whiz technology, and there is precious little transparency of costs and benefits between buyers and sellers.

Innovations at the low end – retail clinics staffed by mid-level clinicians, inexpensive home diagnostic devices, knowledge and online self-help networks organized by and for patients with specific diseases – are generally resisted by the medical establishment, which depends on ever higher revenue streams to feed a high-tech and labor-intensive infrastructure. There is little incentive for a physician to recommend that a patient buy a non-prescription, reliable, easy-to-use cholesterol test kit for $10 when they can come to her office and pay up to ten times that amount for the same result.

There are legitimate issues of quality, safety and reliability of care, but they are becoming less persuasive in light of advances in technology, algorithms to guide evidence-based medicine and online capabilities that make it possible for mid-level clinicians and consumers themselves to diagnose, monitor and treat health conditions in nontraditional settings. As consumers face ever higher health care costs and are expected to pay more of the bill themselves, they will look for ways to reduce costs and still maintain an acceptable quality of care. Of necessity, this will drive innovation at the low end.

This innovation will primarily occur in the private, not the public, sector. The public sector has all the tools and capabilities to drive more cost-effective health care through “disruptive” innovation, but it is controlled by Congress, and Congress is heavily influenced by a medical cartel that needs to find ways to bring more people into hospitals and other high-tech treatment settings. Witness the medical arms race that is occurring in Phoenix and other major urban areas across the country. We are building more hospitals, cancer centers and research facilities. We are lobbying Congress to invest in our biotech and health care industry. We are planning for a future where more people will be sick and need expensive treatments in expensive facilities.

Imagine a future where most chronic diseases will be managed and treated at home. It’s not on the radar of most health facility planners today.

Innovation will occur, regardless. Knowledge and skills move out and across all industries, and health care will not be an exception. Already nurses and technicians are moving into primary care and other clinical spaces traditionally occupied by expensive and highly trained physicians. Already companies are working on home tests for diseases like Alzheimer’s, strep throat, influenza and many others. Already new models of care delivery are being developed that connect patients, clinicians, family and friends in the home, online and in other settings outside of monolithic, stand alone medical facilities.

These facilities aren’t going away. But in the future they will be connected to patients and the community in ways we can’t even imagine today. Visionary health leaders know this. They know you skate to where the puck is going, not where the puck is. They will be among the vanguard of social and technological innovation.

The health care reform debate we are having today is about yesterday, not tomorrow. It’s about protecting the status quo interests of stakeholders in a vast and profitable industry, and consumers who are used to getting expensive care and not having to pay much of their own money for it. We know it’s not sustainable – and innovations in payment and care delivery structures are on the table – but there is little political will to address the fundamental issue of out of control costs.

The future, as they say, has already arrived. It’s just not evenly distributed. If you intend to stay healthy and lower your health care costs, get connected with new ideas, new communities, and new strategies for delivering cost effective care. The innovations are out there, and they are going to usher in an entirely new health care landscape.

It’s just a question of time.

Feedback? Send it my way: Roger.Hughes@slhi.org.

*The Drift reflects the views of the author, and does not represent the official view of SLHI’s Board of Trustees and staff.